Se habla español
Click to Call | Available 24/7

Claim Denied: Your Next Steps If a Workers Compensation Claim Is Not Approved

Nearly 140 million workers in the United States are covered by workers compensation insurance.

Thanks to workers compensation insurance, many Americans are able to rest easy knowing that, if they’re injured at work, they will be able to pay for the care they need. At the same time, though, these workers do not always get the compensation they deserve after being involved in a workplace accident.

Did you recently have a workers compensation claim denied? Are you unsure of why your claim was not approved or what you should do next to cover the cost of your injuries?

If you’re currently dealing with workers comp denial, here are some steps you should take moving forward.

Reasons for Workers Comp Denial

First, you need to understand why your workers compensation claim was denied in the first place. There are a few reasons why your claim might be denied, including the following:

Late Application

If you submitted your application past the due date, you may have inadvertently sent a message to the insurer that your injuries were not as serious as you made them out to be.

No Medical Records

Medical records are a must when you’re filing a workers compensation claim.

Insurance providers need to be able to look at your medical records to understand the extent of your injuries. If you don’t provide any paperwork backing up your claims, they might deny you compensation.

Employer Disputes

You might also have your claim denied if your employer disputes it or says that it didn’t happen the way you say it did.

No Witnesses

Did you have anyone to substantiate your claims? Without witnesses, an insurer may have decided that your claim was not legitimate.

You’re Held Responsible

An insurer may also claim that something you did contributed to your injuries. They might argue that you are at fault and, therefore, do not deserve to be compensated.

What to do Next

If you think that it was unfair for your workers’ compensation claim to be denied, you can appeal the decision. In order to do this, you’ll need to take the following steps:

Contact the Insurance Company

Your first step ought to be to reach out to your employer’s insurance company and find out why they denied your claim. Depending on their reasoning, you might be able to correct the issue right then and there and get them to reconsider your claim.

Hire an Attorney

Once you know the reason the insurance company denied your claim (and whether they’re willing to reconsider it), you might need to hire an attorney.

If you’re going to try and appeal the decision to deny your claim, it’s especially important to have an attorney on your side.

In most cases, a workers compensation attorney will be paid a percentage of the benefits you receive from your claim. If this is the case for the attorney you hire, you won’t need to worry about their fees while you’re going through the appeal process.

An attorney can be a huge help when you’re trying to appeal a claim denial. They’ll be able to tell you why your claim was denied and help you gather evidence, contact witnesses, and obtain opinions from experts that back up your initial claim.

Should the appeal go to court, an attorney will play an even bigger role in arguing on your behalf.

File the Appeal

Once you’ve hired an attorney, your next step will be to actually file a formal appeal.

Your attorney will be able to help you through this process and ensure you do everything correctly (and file it within a specific time period). Every state gives you a specific time frame during which you can file an appeal and have it considered.

Mediation

Your appeal can take place in a formal hearing setting. But, before this, most states will give you the option to participate in mediation first.

Mediation involves you and the insurance company sitting down together and presenting your case to a mediator. A mediator is a neutral individual who will help you try to reach an agreement.

Mediation is less formal than a hearing and usually takes place in a conference room or other neutral space. It’s a good idea to have your attorney with you during the mediation process. They can help you craft your arguments and present your case in a way that will be convincing to the mediator.

If you and the insurer reach an agreement during mediation, that agreement will be formalized in writing. It will also be reviewed by a judge.

Formal Hearing

If you can’t reach an agreement during mediation, you’ll need to attend a formal hearing.

During the hearing, you (and your attorney) and the insurance provider will make an argument and present evidence backing up that argument. A judge will preside over the hearing.

Board Appeal

If a formal hearing is unsuccessful, you may be able to file an administrative appeal. In this case, you will work with the workers’ compensation appeals board or a panel or workers’ compensation judges.

The insurance company can also appeal if they’re unhappy with the workers’ compensation judge’s decision.

Court Appeal

The last step you and your attorney can take (on a state level, at least) is to appeal through your state’s court system.

If things escalate to this level, your case will be handled like any other lawsuit and a judge or jury will decide the outcome.

Hire a Workers Comp Lawyer Today

Now that you know a bit more about workers comp denial and why your case may have been denied, it’s time to take steps to appeal the decision and get the compensation you deserve.

If you’re feeling overwhelmed by this or aren’t sure where to turn, we’re here to help at Bader Scott Injury Lawyers.

Since we first opened our doors, we’ve uncovered millions of dollars in personal injury and workers compensation claims for our clients.

Contact us today for a free case review to see how we can help you.

Seth Bader is an Auto accident, Workers Compensation and Personal Injury Attorney who practices in Atlanta, Rome, Savannah, Norcross, Carrollton, Georgia. He graduated from Florida State University College of Law, and has been practicing law for 14 years. Seth Bader believes in fighting for the injured. Learn more about his experience by clicking here.

◂ Back to Blog
Seth Bader

Seth Bader Law Firm Logo

(678) 562-5595